Abstract
BackgroundAccessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, particularly for young people. Young people facing humanitarian crises are also at higher risk for mental health problems, which can further exacerbate poor SRH outcomes. This review aimed to explore, describe and evaluate SRH interventions for young people in LMIC and humanitarian settings to better understand both SRH and psychosocial components of interventions that demonstrate effectiveness for improving SRH outcomes.MethodsWe conducted a systematic review of studies examining interventions to improve SRH in young people in LMIC and humanitarian settings following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Peer-reviewed journals and grey literature from January 1, 2000 to December 31, 2018 were included. Two authors performed title, abstract and full-text screening independently. Data was extracted and analyzed using a narrative synthesis approach and the practice-wise clinical coding system.ResultsThe search yielded 813 results, of which 55 met inclusion criteria for full-text screening and thematic analysis. Primary SRH outcomes of effective interventions included: contraception and condom use skills, HIV/STI prevention/education, SRH knowledge/education, gender-based violence education and sexual self-efficacy. Common psychosocial intervention components included: assertiveness training, communication skills, and problem-solving.ConclusionsFindings suggest that several evidence-based SRH interventions may be effective for young people in humanitarian and LMIC settings. Studies that use double blind designs, include fidelity monitoring, and focus on implementation and sustainability are needed to further contribute to this evidence-base.
Highlights
Accessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, for young people
We focused on LMICs because the resources available to address humanitarian crises in these settings are much different than those available in high-income countries, and a significant proportion of displaced persons seeking refuge from humanitarian emergencies are hosted by developing countries [2]
For the purposes of consolidating key findings of this review, we discuss below the results from thematic analysis of these 17 studies that reported intervention effectiveness on SRH outcomes over time among adolescents and young adults
Summary
Accessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, for young people. It is estimated that nearly two billion people worldwide live in areas affected by conflict and violence, and the number of forcibly displaced people is at its highest record to date, at over 68.5 million people worldwide [1] Of those people in need of humanitarian assistance, an estimated 34 million are adolescent girls and women of reproductive age [2, 3]. Further research is needed to better understand which SRH interventions have demonstrated effectiveness for improving SRH outcomes in LMIC and humanitarian settings in order to increase evidence-based practices and inform decisions to invest in scaling-up of effective intervention packages
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